For the first half of this century, barbiturates were the only pharmacological option available for insomnia. Veronal, the first barbiturate, was introduced in 1903. In the years following, about fifty drugs of this class reached the market (out of nearly twenty-five hundred barbiturate compounds developed in the lab). However, barbiturates were found to have two dangerous drawbacks: a high potential for addiction and a great risk of lethal overdose. Today only a dozen or so are still available; those used primarily for sleep are secobarbital (Seconal), amobarbital (combined with secobarbital in a product called Tuinal), and pentobarbital (Nembutal). Other uses for barbiturates are as antianxiety agents, anesthetics, and anticonvulsants.
In the late 1950s tricyclic antidepressants came on the market. In addition to their effect on serious depression, some of these drugs also possess sedative effects, although just how they work is not completely understood. Antidepressants offered an alternative to the potential dangers of barbiturates, but they too have undesirable side effects. While not considered the drug of first choice today, antidepressants may be used to alleviate insomnia—especially if the insomnia is associated with depression.
A major breakthrough in the drug treatment of insomnia was achieved with the arrival of benzodiazepines in the early 1960s. Compared to their prescription drug predecessors, benzodiazepines—primarily flurazepam, temazepam, and triazolam—have a greatly improved safety profile and are much more effective, particularly in disorders of initiating and maintaining sleep in individuals whose insomnia lacks an identifiable physical cause. Their improved ratio of therapeutic dose to lethal dose means a much lower risk of abuse or dangerous adverse effects. Some research does indicate, however, that there is a potential for addiction in patients taking the drugs over long periods of time. Benzodiazepines fall into several subcategories, usually depending on how quickly and for how long the drug works.
Of course, there are also several nonprescription sleeping aids available (brand names include Nytol, Sominex, and Sleep-Eze).
In all of these the active ingredient is the same: diphenhydramine, a form of antihistamine. As you may know, antihistamines are used to dry up secretions in the eyes, nose, and throat, thus relieving some symptoms of colds and allergies. The drowsiness caused by antihistamines is really only a side effect; makers of over-the-counter sleeping aids have thus taken a drug liability and marketed it as an asset. Antihistamines may prove especially useful in the treatment of insomnia complicated by a history of drug or alcohol abuse, since they do not have the potential for abuse that is associated with other drug therapies (such as benzodiazepines and barbiturates).
*270\226\8*

THE EVOLUTION OF INSOMNIA DRUG THERAPYFor the first half of this century, barbiturates were the only pharmacological option available for insomnia. Veronal, the first barbiturate, was introduced in 1903. In the years following, about fifty drugs of this class reached the market (out of nearly twenty-five hundred barbiturate compounds developed in the lab). However, barbiturates were found to have two dangerous drawbacks: a high potential for addiction and a great risk of lethal overdose. Today only a dozen or so are still available; those used primarily for sleep are secobarbital (Seconal), amobarbital (combined with secobarbital in a product called Tuinal), and pentobarbital (Nembutal). Other uses for barbiturates are as antianxiety agents, anesthetics, and anticonvulsants.In the late 1950s tricyclic antidepressants came on the market. In addition to their effect on serious depression, some of these drugs also possess sedative effects, although just how they work is not completely understood. Antidepressants offered an alternative to the potential dangers of barbiturates, but they too have undesirable side effects. While not considered the drug of first choice today, antidepressants may be used to alleviate insomnia—especially if the insomnia is associated with depression.A major breakthrough in the drug treatment of insomnia was achieved with the arrival of benzodiazepines in the early 1960s. Compared to their prescription drug predecessors, benzodiazepines—primarily flurazepam, temazepam, and triazolam—have a greatly improved safety profile and are much more effective, particularly in disorders of initiating and maintaining sleep in individuals whose insomnia lacks an identifiable physical cause. Their improved ratio of therapeutic dose to lethal dose means a much lower risk of abuse or dangerous adverse effects. Some research does indicate, however, that there is a potential for addiction in patients taking the drugs over long periods of time. Benzodiazepines fall into several subcategories, usually depending on how quickly and for how long the drug works.Of course, there are also several nonprescription sleeping aids available (brand names include Nytol, Sominex, and Sleep-Eze).In all of these the active ingredient is the same: diphenhydramine, a form of antihistamine. As you may know, antihistamines are used to dry up secretions in the eyes, nose, and throat, thus relieving some symptoms of colds and allergies. The drowsiness caused by antihistamines is really only a side effect; makers of over-the-counter sleeping aids have thus taken a drug liability and marketed it as an asset. Antihistamines may prove especially useful in the treatment of insomnia complicated by a history of drug or alcohol abuse, since they do not have the potential for abuse that is associated with other drug therapies (such as benzodiazepines and barbiturates).*270\226\8*

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